CLINTON PROMISES NOT TO SURRENDER ON UNIVERSAL CARE

By ROBIN TONER,

Published: June 22, 1994

WASHINGTON, June 21—
Despite a week of panicky pleas for compromise from Capitol Hill, President Clinton vowed today that he would not "declare defeat" on the goal of guaranteeing health insurance to every American.

Mr. Clinton's pledge, in a speech to executives from the nation's biggest companies, appeared to have several political purposes, like bucking up Democratic loyalists in the House, many of whom are going out on a political limb to advance a universal coverage bill. It also signaled the Senate, and particularly a very divided Senate Finance Committee, that covering everyone is a goal that will not be compromised.

In addition, the President's vow reflected the new effort by the Administration to present Mr. Clinton as a principled protector of the middle class in the health care struggle. The Administration asserts that it is this group -- not the poor or the rich -- that would be the main beneficiary of guaranteed health insurance, and thus the big loser if it is traded away.

"We're the only people that can't figure out how to cover everybody," an impassioned Mr. Clinton told the Business Roundtable, which rebuffed the President last February by endorsing a rival health care plan that fell short of promising universal coverage. "I refuse to declare defeat. Why should we jump in the tank?"

Even as the President was trying to escalate the pressure on Capitol Hill, however, there was new evidence of how tangled and delayed the process has become there. Senator Daniel Patrick Moynihan of New York, chairman of the Senate Finance Committee, told his panel today that he cannot get the necessary financial analyses for the health plan that he has offered or for a Republican alternative until mid-July. As a result, Mr. Moynihan said, his committee will not be able to begin voting on a bill until after the July Fourth recess but, he added, it will try to reach an agreement before then.

Only last Sunday, Mr. Moynihan said that the next two weeks were absolutely critical to producing a health care bill this year. Still, Senator George J. Mitchell of Maine, the majority leader, said today that Mr. Moynihan's announcement would not keep Mr. Mitchell from getting a health care bill to the floor of the full Senate in July.

All of this is feeding into the bicameral jitters on Capitol Hill. House Democratic leaders say they believe they can get a bill with universal coverage passed in their chamber, but members there have watched the logjam in the Senate Finance Committee with increasing alarm. House Democrats fear a repeat of the summer of 1993, when they cast a tough vote for a broad-based energy tax, at the President's pleading, only to see it instantly jettisoned in the Senate.

This fear was only stoked in recent days as Mr. Moynihan, in several forums, argued the case for a greater and greater compromise with Republicans and others who resist a speedy commitment to universal coverage -- largely because it would require businesses to pick up much of the cost.

In that context, Mr. Clinton sought to delineate today where he would and would not give -- and he followed up the hard line set by his wife, Hillary, in a speech on Monday.

He noted that there were many objections to the health plan he submitted last winter, but argued that the Administration had listened to them. "We're making the changes that we heard people complain about," he said. One change is to make membership voluntary in the insurance purchasing pools known as alliances.

"We may have to do more for small business," he said. "I'm willing to do that. We may have to do more, and we should, to make the thing less regulatory. I've already made a lot of those changes. But let us not walk away."

Mr. Clinton asserted that simply changing insurance industry rules -- as is advocated by many Republicans -- would not bring about the fundamental change that is needed. "You look at the experience of New York," he said, "that tried to mandate insurance reforms alone. What happens? A lot of people's insurance goes up, and a lot more people opt out of the system.

"There is no compelling evidence that we can both have quality and cost control and stop cost shifting in the absence of covering everyone," Mr. Clinton added. "There is no compelling evidence." Business Expresses Concern

The Business Roundtable did not echo the President's call for universal coverage in a letter delivered to Congress today. It called for health care legislation that would "increase coverage," maintain quality and control costs. But it expressed a variety of concerns about proposals now under consideration in Congress, including one that tries to break the legislative logjam by easing new requirements on small business.

"The Roundtable objects to the imposition of requirements (taxes or employer mandates) based on the size of the employer," the letter said. "New costs hurt large employers as much as they hurt small business."

Given the stakes of the struggle, and the attempts to finesse divisions, the definition of "universal coverage" will be a major part of the debate to come. Lorrie McHugh, a spokeswoman for the White House on health, said after the President's speech that the Administration defines universal coverage as a situation where "every American is guaranteed in law health care coverage that can never be taken away." Administration Flexibility

The White House has indicated some flexibility on the phasing-in of universal coverage, but "it has to be within a reasonable time period and by a date certain," Ms. McHugh added. Such phasing-in would occur under proposals for what has become known as a "hard trigger," which would impose new requirements on business automatically if certain goals for coverage were not met.

But Ms. McHugh said the Administration is wary of "soft trigger" proposals, which would require further Congressional action to impose new requirements on business if the goals for coverage were not met. "We're not convinced this would necessarily lead to universal coverage," she said. Such proposals are widely discussed in the Senate these days, where many do not believe there are the votes even for a "hard trigger."

The White House has clearly decided, however, to try to stay above this maneuvering and keep the President and Mrs. Clinton talking about the big issues -- especially about giving every American a guarantee that has been sought unsuccessfully since the Presidency of Franklin D. Roosevelt.

This was cheered by some Democrats on Capitol Hill: "If we can be strong,he better be," said Representative Barbara Kennelly, a Connecticut Democrat on the House Committee on Ways and Means. "We've been hearing for 10 years that we can't do health care until we have a President who wants health care in the bully pulpit. Now we have one, and he's got to use it every day."

Administration allies said they were also cheered by the Republicans' posture of recent days, arguing that their clear partisanship was leaving them open to charges of obstructionism. Republicans do, in fact, appear to be fighting that image; Representative Newt Gingrich, the No. 2 Republican in the House, said today, "We beg the Democratic leadership, let us work together on a bipartisan bill that is centrist."

He added, however, "Do not try to pass a big-government, tax-increase, big-bureaucracy bill only with Democratic votes."

Photo: President Clinton left the room at the Marriott Hotel in Washington yesterday after telling business executives that he will continue his fight for a health plan that guarantees coverage for all Americans. The executives are members of the Business Roundtable. (Paul Hosefros/The New York Times) (pg. A18)